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ⅠA~ⅡA期宫颈癌盆腔淋巴结转移的高危因素

来源:用户上传      作者:施姚 王兰英 汪棋秦 徐一腾 徐佳楠 黄春芳 张星光

  [摘要] 目的 探讨ⅠA~ⅡA期宫颈癌盆腔淋巴结转移的高危因素。 方法 对浙江省余姚市人民医院2014年1月至2018年12月217例行开腹或腹腔镜下广泛子宫切除+盆腔淋巴结清扫术的ⅠA~ⅡA期宫颈癌患者的临床病理资料进行回顾性分析,运用多因素logistic回归分析研究发生盆腔淋巴结转移的高危因素。 结果 217例患者中,有44例盆腔淋巴结发生转移,转移率为20.3%,其中发生闭孔淋巴结转移最高,转移率为16.1%。χ2检验分析得出,宫颈癌临床分期、肿瘤大小、分化、宫颈间质浸润深度、脉管有无浸润及宫旁有无浸润与盆腔淋巴结转移相关(P<0.05)。多因素logistic回归分析显示,肿瘤分期Ⅱ期、肿瘤≥4 cm、宫颈间质浸润≥1/2、低分化、脉管阳性及宫旁浸润是盆腔淋巴结转移的独立危险因素(P<0.05)。 结论 肿瘤分期Ⅱ期、肿瘤≥4 cm、宫颈间质浸润≥1/2、低分化、脉管阳性及宫旁浸润容易发生盆腔淋巴结转移,建议系统性盆腔淋巴结清扫。
  [关键词] 宫颈癌;盆腔淋巴结转移;高危因素;清扫
  [中图分类号] R737.3 [文献标识码] B [文章编号] 1673-9701(2022)13-0063-03
  [Abstract] Objective To investigate the high-risk factors for pelvic lymph node metastasis in patients with stage ⅠA-ⅡA cervical cancer. Methods The clinicopathological data of 217 patients with stage ⅠA-ⅡA cervical cancer who underwent laparotomy or laparoscopic extensive hysterectomy and pelvic lymph node dissection from January 2014 to December 2018 in Yuyao People′s hospital in Zhejiang Province were retrospectively analyzed. The high-risk factors for pelvic lymph node metastasis were analyzed by multivariate Logistic regression analysis. Results 44 of the 217 patients had pelvic lymph node metastasis, with a metastasis incidence of 20.28%. Where, obturator lymph node metastasis was the most commonly involved, with a metastasis incidence of 16.13%. Univariate analysis showed that clinical stage of the cervical cancer, tumor size, depth of cervical interstitial invasion, tumor differentiation, and the presence or absence of vascular invasion and parametrial invasion were related to pelvic lymph node metastasis(P<0.05).Multivariate Logistic regression analysis showed that stage Ⅱ tumor, tumor≥4 cm,cervical interstitial invasion≥1/2,low differentiation,positive vascular invasion and the presence of parametrial invasion were independent risk factors for pelvic lymph node metastasis(P<0.05). Conclusion It is easier to develop pelvic lymph node metastasis in the case of stage Ⅱtumor, tumor ≥4 cm, cervical interstitial invasion≥1/2,low differentiation, positive vascular invasion,and parametrial invasion. Systemic pelvic lymph node dissection is recommended.
  [Key words] Cervical cancer; Pelvic lymph node metastasis; High-risk factors; Dissection
  m颈癌在妇科恶性肿瘤中发病率最高,发病的高峰年龄为40~60岁,发病的年龄越来越年轻化。宫颈癌是目前病因明确的妇科恶性肿瘤,与高危型人乳头瘤病毒的持续性感染相关。近20年来宫颈液基细胞学和人乳头瘤病毒联合筛查的广泛应用,能够早期发现宫颈病变,并及时得到治疗,宫颈癌的发病率和死亡率已明显下降。目前,广泛性子宫切除及盆腔淋巴结清扫术仍为宫颈癌的标准术式。2018新的国际妇产科联盟(international federation of gynecology and obstetrics,FIGO)已经把盆腔淋巴结的转移加入到新的分期中[1],说明它是治疗早期宫颈癌重要的预后因素和决定标准,盆腔淋巴结有无转移与后续治疗和疾病预后密切相关。但对分期较早的宫颈癌,淋巴结的清扫是选择性或系统性,在临床上仍有不少争议,因为淋巴清扫会带来一系列的并发症,如下肢水肿、淋巴囊肿及感染等,本研究通过统计分析2014年1月至2018年12月浙江省余姚市人民医院ⅠA~ⅡA期宫颈癌的临床及有关病理资料,探讨早期宫颈癌患者盆腔淋巴结转移的分布规律及影响因素,为临床工作提供理论指导,现报道如下。

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